Laryngopharyngeal symptoms in patients with chronic obstructive pulmonary disease.

UNLABELLED: The aim of the study was to report on the prevalence and severity of laryngopharyngeal symptoms in patients with COPD compared to controls. A total of 27 patients with COPD and 13 controls matched according to age and gender were included. Demographic data included age, gender, history of smoking and history of allergic rhinitis. The Reflux symptom Index described by Belafsky et al. was used. The frequency and average score of each of the laryngopharyngeal symptoms were computed. The mean age of patients was 61.67 ± 11.09 years. Ninety-two percent were smokers and 11.1 % had allergy rhinitis. The mean of Total Reflux Symptom index in patients was significantly higher compared to controls (12.70 ± 7.06 vs. 3.00 ± 2.94). In the COPD group, 18 subjects had a positive Reflux symptom index (>11) compared to one in the control group (p value <0.05). There was also a significant difference between the means of six laryngopharyngeal symptoms in patients vs. CONTROLS: COPD patients had higher degree of hoarseness, throat clearing, excessive throat mucus, cough and sticking sensation in the throat. Laryngopharyngeal reflux is more prevalent in patients vs. CONTROLS: The frequency and severity of laryngopharyngeal symptoms is significantly higher in COPD patients.

Unusual presentation of a sarcoid patient: multiple arterial and venous thrombosis with chest lymphadenopathy.

We depict a case of a 32 year old Mediterranean man, presenting with pulmonary embolism, and diffuse arterial thrombosis of the lower extremities. CT angiography revealed bilateral pulmonary artery occlusions and a mediastinal lymphadenopathy. Duplex Ultrasound of the lower extremities showed no deep venous thrombosis, but occluded popliteal arteries bilaterally with extension to the right distal superficial femoral artery. Mediastinoscopy with hilar lymph node biopsy showed noncaseating granulomas consistent with sarcoidosis. Thrombophilia profile revealed factor II, MTHFR, and factor XIII gene mutations with markedly elevated homocysteine level of 139 mumol/l. This is an atypical rare case of sarcoidosis presenting with pulmonary embolism and multiple arterial thrombosis.

Extramedullary hematopoiesis in a patient with beta-thalassemia intermedia manifesting as symptomatic pleural effusion.

A case of bilateral paravertebral extramedullary hematopoietic masses with symptomatic pleural effusion in a patient with beta-thalassemia intermedia is reported. The pleural effusion was controlled by pleurodesis using tetracycline. We review the literature on this uncommon complication of beta-thalassemia intermedia and discuss the options for diagnosis and treatment.

Comparative study of antituberculous drug resistance among Mycobacterium tuberculosis isolates recovered at the American University of Beirut Medical Center: 1996-1998 vs 1994-1995.

PURPOSE: To study the overall current prevalence of antituberculous drug resistance among M. tuberculosis isolates recovered at the American University of Beirut Medical Center (AUBMC) between 1996-1998 in comparison to those reported on isolates recovered in 1994-1995. MATERIALS AND METHODS: Seventy-four consecutive M. tuberculosis isolates recovered from the same number of newly diagnosed cases of tuberculosis (TB), between January 1996 and December 1998 (referred to as 1998), were tested against isoniazid (INH), rifampicin (RIF), streptomycin (STM) and ethambutol (ETH), using the BACTEC-TB susceptibility procedure and system. The results were compared to those reported on the isolates recovered in 1994-1995 (referred to as 1995). RESULTS: A comparison between the results obtained in 1998 vs 1995 showed the following, respectively: The male to female ratio was 3.1:1 vs 2:1 and the mean ages were almost similar in males, 33.4 vs 34.1 years but were slightly higher in females 38.2 vs 32.7 years. Children (< or = 15 yrs) represented 10.8% vs 8.3% of the study population. The prevalence of resistance, to one or more drugs, was almost the same, 24% vs 26% but the overall percentages of single drug resistance were generally higher in 1998 vs 1995 against all the tested drugs except INH: INH (20.2% vs 23.9%), RIF (16.2% vs 12.5%), STM (13.5% vs 7.3%) and ETH (8.1% vs 3%). Among the resistant isolates, the profiles of resistance indicated decrease in resistance to one and two drugs, 6.7% vs 11.5% and 5.4% vs 10.4%, respectively, but showed increase in resistance to three and four drugs, 8.1% vs 2.1% and 4% vs 2.1%, respectively. Increase in resistance to two or more drugs was also observed, 17.6% vs 14.6%, and the prevalence of multidrug resistance, defined as resistance to at least both INH and RIF, was also increased, 14.7% vs 11.4%. CONCLUSIONS: This study shows a high prevalence and persistence of TB drug resistance tested in our Medical Center in Lebanon. In addition, the shift in the increase of resistance from one and two drugs to three and four drugs are very ominous and should be considered when treating patients in this country. Moreover, such information calls for scrutinizing the existing local TB control programs as part of the global efforts to minimize the incidence of this highly morbid infectious disease.

Relation of ferritin levels to pulmonary function in patients with thalassemia major and the acute effects of transfusion.

We studied 36 patients (17 males and 19 females) with thalassemia major by performing pulmonary function testing (PFT), arterial blood gas analysis (ABG), as well as determining the serum ferritin level. In addition, 19 of these patients were transfused with two units of packed cells, and a repeat ABG and PFT were performed. Twenty-three patients had normal PFTs, eleven patients (30.6%) showed a restrictive pattern (significant decrease in both TLC and DLCO), and only two patients (5.6%) showed an obstructive pattern. A significant negative correlation was found between serum ferritin and restrictive parameters, DLCO and TLC (p = 0.01 and p = 0.03, respectively). This correlation was even stronger after transfusion. Controlling for age, ferritin was still negatively correlated with DLCO (p = 0.04), but no longer with TLC. There was no correlation between age and DLCO or age and TLC; however, there was a statistically significant negative correlation between age and FVC (p = 0.003). Analysis of patients who were transfused revealed a significant decrease in forced vital capacity (89 +/- 4% vs. 74 +/- 5% of predicted; p-value < 0.001) and in maximum midexpiratory flow rate (79 +/- 4% vs. 67 +/- 5% of predicted; p-value = 0.004). For patients older than 15 yr of age, there was a statistically significant decrease in FEV1/FVC (84 +/- 2 vs. 83 +/- 2%; p-value = 0.04). The ABGs showed no significant change post-transfusion. In this study, PFT findings in thalassemia major were restrictive and correlated with serum ferritin level. Transfusion had an acute effect on the obstructive parameters of PFT.

Reversal of impaired calcium homeostasis in the rat diaphragm subjected to Monocrotaline-induced pulmonary hypertension.

Monocrotaline (MCT) pneumotoxicity is known to alter the structure of pulmonary vascular wall and impairs endothelial cell function resulting in pulmonary hypertension. Its effect on the diaphragm muscle has not yet been elucidated. This study examines the effect of MCT pneumotoxicity on calcium transport in the rat diaphragm. Pulmonary hypertension induced by MCT pneumotoxicity caused a significant increase (P < 0.001) in calcium accumulation in strips isolated from rat diaphragms. Treatment of rats having received MCT with Indapamide reduced calcium uptake by diaphragmatic strips to levels that are not significantly different from the control (P > 0.05). Treatment with Indapamide alone did not elicit any change in calcium accumulation in the diaphragmatic strips. Treatment of the animals with MCT, Indapamide or both did not produce any significant change (P > 0.05) in the cell volume of the diaphragmatic strips. Pulmonary hypertension increased calcium uptake by the muscle cells in the rat diaphragm which may alter diaphragmatic contractility; an effect that was prevented by Indapamide.

Effects of capsaicin and capsaicin desensitization on alanine accumulation in rat hemidiaphragms.

1. Alanine accumulation in rat hemidiaphragms is significantly inhibited by capsaicin in a dose-dependent pattern that produced maximal effect at 1 mM. 2. The inhibitory effect of capsaicin on alanine accumulation by rat hemidiaphragms was enhanced upon preincubation with 5 mM ouabain. However, preincubation with 1 mM Verapamil did not alter the inhibitory effect of capsaicin. 3. Chemical ablation of the capsaicin-sensitive primary afferent fibers abolished the inhibitory effect of capsaicin on alanine accumulation in the rat hemidiaphragms.

Straight pin aspiration in young women.

Straight pins are used extensively for securing facial scarves in women and girls in the Middle East. Accidental aspiration often results in the pin lodging in the segmental bronchus with the sharp end pointing cephalad. Flexible bronchoscopy is superior to rigid bronchoscopy in retrieving these pins. We report on five cases successfully treated by fiberoptic bronchoscopy under general anesthesia.

Effects of aminophylline and terbutaline sulfate on the contractility of feline diaphragm.

1. The effect of aminophylline and terbutaline sulfate, separately and in combination, on the contractility of the feline diaphragm was investigated. 2. Diaphragmatic contractility increased significantly (P less than 0.05) to 28.3% above control level as long as theophylline plasma levels were maintained between 10-20 mg/l (mean 13.9 +/- 0.8 mg/l). 3. Diaphragmatic contractility showed a significant (P less than 0.05) 41.5% increase after i.v. administration of terbutaline sulfate as a maintenance dose of 1.4 micrograms/kg-hr, and the increase leveled off after 180 min. 4. Administering the two drugs in combination showed a significant (P less than 0.05) 27.3% increase which suggests a non-synergistic effect of aminophylline and terbutaline sulfate on diaphragmatic contractility. 5. By enhancing the contractility of the diaphragm, aminophylline and terbutaline sulfate may improve the clinical status of patients with airway obstructive diseases and help in preventing respiratory muscle fatigue.

Digoxin-stimulated calcium transport across rat diaphragm interactions with aminophylline and verapamil.

1. The effect of digoxin on calcium transport across muscle strips isolated from rat diaphragms was investigated. 2. Digoxin at concentrations ranging between 0.2-5.0 ng/ml in the incubation solution increased significantly (P less than 0.5) intracellular calcium in the diaphragm muscle strips in a dose-dependent pattern. 3. The inclusion of digoxin (2 ng/ml) and aminophylline (18.75 micrograms/ml) in the incubation medium showed a significant increase (P less than 0.001) in calcium uptake suggesting a synergistic effect on intracellular calcium accumulation. 4. The presence of digoxin with verapamil in the incubation medium showed a partial alleviation of the inhibitory effect of verapamil on calcium transport. 5. The effect of increasing calcium concentration in the presence of digoxin and digoxin plus aminophylline in the incubation medium, showed a nonsaturable linear relationship between calcium concentration and intracellular calcium accumulation.

Interactions and effects of aminophylline, terbutaline sulfate and verapamil on calcium transport across rat diaphragm.

The effect of terbutaline sulfate on calcium transport across muscle strips isolated from rat diaphragms, and its effect on this process when used in combination with aminophylline was investigated using labelled calcium in a two-compartment system. The results show that terbutaline sulfate causes a dose-dependent increase in intracellular calcium concentration which reached saturation at a terbutaline sulfate concentration of 2 ng/ml. The inclusion of both aminophylline and terbutaline sulfate at a concentration range of 6.25-50 micrograms/ml and 0.5-4 ng/ml respectively in the incubation medium, did not show a synergistic effect on intracellular calcium accumulation. Although verapamil, a calcium channel blocker, inhibited significantly (P less than 0.01) calcium accumulation in the muscle strips of the diaphragm, it did not inhibit completely the increase in intracellular calcium concentration noticed in the presence of aminophylline or terbutaline sulfate. This would suggest that aminophylline and terbutaline sulfate have an effect on the calcium channels in the muscle strips of the diaphragm.